Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal.
Biomedicine Department, Faculty of Medicine of the University of Porto, Porto, Portugal.
Postgrad Med. 2022 May;134(4):435-440. doi: 10.1080/00325481.2022.2058285. Epub 2022 Mar 30.
The burden of nonalcoholic fatty liver disease (NAFLD) is increasing, with an estimated prevalence in Europe of 20-30%. Although most patients present with simple steatosis, some progress to advanced fibrosis, cirrhosis, and hepatocellular carcinoma. Definite diagnosis and staging require liver biopsy, which is not feasible given the high prevalence of NAFLD. As such, several noninvasive tools have been formulated. However, to date, none have been validated in the Portuguese population. The aim of this study was to determine the diagnostic accuracy of the aspartate aminotransferase to platelet ratio (APRI), the BMI, AST/ALT ratio and Diabetes (BARD), the FIB-4 Index (FIB-4), the Hepamet fibrosis score (HFS), and the NAFLD fibrosis score (NFS) in a Portuguese population.
A retrospective review of liver biopsies from two hospital centers was performed. Patients with NAFLD and no decompensated cirrhosis, liver cancer, or terminal illness were included. APRI, BARD, FIB-4, HFS, and NFS were calculated for each patient.
A total of 121 individuals were included, of which 21.5% had advanced fibrosis (F ≥ 3). There was a moderate or high correlation between most tools. The negative predictive factor (NPV) and area under receiver operating curve (AUROC) were 89.9% and 0.80 for APRI, 91.8% and 0.84 for BARD, 95.7% and 0.88 for FIB-4, 96.4% and 0.88 for HFS, and 93.0% and 0.86 for NFS, respectively.
The tools analyzed had excellent performance (AUROC ≥ 0.80) and were adequate for ruling out advanced fibrosis (NPV ≥ 89.9%) in a Portuguese population. As such, they are adequate for use in clinical practice or as a part of referral and follow-up programs wherever this population is treated.
APRI - aspartate aminotransferase to platelet ratio, ALT - alanine aminotransferase, AST - aspartate aminotransferase, BARD - BMI, AST/ALT ratio and Diabetes, BMI - body mass index, FIB-4 - FIB-4 index, HCC - hepatocellular carcinoma, HFS - Hepamet fibrosis score, HOMA-IR - homeostatic model assessment for insulin resistance, IQR - interquartile range, MAFLD - metabolic associated fatty liver disease, NAFLD - nonalcoholic fatty liver disease, NASH - nonalcoholic steatohepatitis, NFS - NAFLD fibrosis score, OMIC - genomics, transcriptomics, proteomics, and metabolomics, T2DM - type 2 diabetes mellitus.
非酒精性脂肪性肝病（NAFLD）的负担正在增加，据估计，欧洲的患病率为 20-30%。尽管大多数患者表现为单纯性脂肪变性，但有些患者会进展为晚期纤维化、肝硬化和肝细胞癌。明确诊断和分期需要肝活检，但由于 NAFLD 的高患病率，这是不可行的。因此，已经制定了几种非侵入性工具。然而，迄今为止，在葡萄牙人群中尚未对这些工具进行验证。本研究的目的是确定天冬氨酸氨基转移酶与血小板比值（APRI）、体重指数（BMI）、天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值和糖尿病（BARD）、FIB-4 指数（FIB-4）、Hepamet 纤维化评分（HFS）和 NAFLD 纤维化评分（NFS）在葡萄牙人群中的诊断准确性。
对来自两个医院中心的肝活检进行回顾性分析。纳入有 NAFLD 且无失代偿性肝硬化、肝癌或终末期疾病的患者。为每位患者计算 APRI、BARD、FIB-4、HFS 和 NFS。
共纳入 121 名患者，其中 21.5%有晚期纤维化（F≥3）。大多数工具之间存在中度或高度相关性。APRI 的阴性预测值（NPV）和受试者工作特征曲线下面积（AUROC）分别为 89.9%和 0.80，BARD 为 91.8%和 0.84，FIB-4 为 95.7%和 0.88，HFS 为 96.4%和 0.88，NFS 为 93.0%和 0.86。
在葡萄牙人群中，分析的工具具有出色的性能（AUROC≥0.80），可排除晚期纤维化（NPV≥89.9%）。因此，它们可在临床实践中或在治疗该人群的转诊和随访计划中使用。
APRI-天冬氨酸氨基转移酶与血小板比值，ALT-丙氨酸氨基转移酶，AST-天冬氨酸氨基转移酶，BARD-体重指数、天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值和糖尿病，BMI-体重指数，FIB-4-FIB-4 指数，HCC-肝细胞癌，HFS-Hepamet 纤维化评分，HOMA-IR-稳态模型评估的胰岛素抵抗，IQR-四分位距，MAFLD-代谢相关脂肪性肝病，NAFLD-非酒精性脂肪性肝病，NASH-非酒精性脂肪性肝炎，NFS-NAFLD 纤维化评分，OMIC-基因组学、转录组学、蛋白质组学和代谢组学，T2DM-2 型糖尿病。
